The Role of Extended Resection in Pancreatic Adenocarcinoma: Is There Good Evidence-Based Justification?Hartel M. · Wente M.N. · Di Sebastiano P. · Friess H. · Büchler M.W.
Department of General Surgery, University of Heidelberg, Heidelberg, Germany
Thus far, there are no studies concerning the radicality of pancreaticoduodenectomy which, in well-performed, randomized-controlled trials employing high standards of evidence-based medicine, show a benefit over extended lymphadenectomy. The results of the only two prospective randomized studies are not comparable and both are underpowered (level of evidence Ib). Therefore, it is still unclear whether extended lymphadenectomy for pancreatic carcinoma improves outcome. Only one study suggests a positive tendency toward increased survival rates in node-positive patients. Extended approaches including additional venous resection can be performed without a rise in the morbidity and mortality rates of patients with pancreatic carcinoma. In the future appropriately powered randomized trials of standard vs. extended resections may show the benefit of extended surgical resections. In addition, well powered trials of postoperative adjuvant therapies or preoperative neoadjuvant strategies together with surgical resections may identify more effective combinations showing a survival benefit in patients with pancreatic carcinoma.
© 2004 S. Karger AG, Basel and IAP
Helmut Friess, MD
Department of General Surgery, University of Heidelberg
Im Neuenheimer Feld 110, DE–69120 Heidelberg (Germany)
Tel. +49 6221 56 4860, Fax +49 6221 56 6903
Published online: November 15, 2004
Number of Print Pages : 6
Number of Figures : 0, Number of Tables : 2, Number of References : 36
Vol. 4, No. 6, Year 2004 (Cover Date: 2004)
Journal Editor: M.V. Singer, Mannheim; C.W. Imrie, Glasgow
ISSN: 1424–3903 (Print), eISSN: 1424–3911 (Online)
For additional information: http://www.karger.com/pan